High-risk endometrial cancer in young indigent women

OBJECTIVE: The aim of this study was to evaluate a different prevalence and clinical pattern of high-risk endometrial cancer in an indigent population of young women. METHODS: Charts of 71 consecutive patients, treated for endometrial adenocarcinoma during a 6-year period, were reviewed. The patients were divided into two groups contingent upon age--(i) those who were below 40 years and (ii) those who were over 40. Based on histological type, grade, and stage, both groups were subdivided into a low, intermediate, or high-risk cancer category. RESULTS: Of the 13 (18.3%) patients in the younger age group, five patients (38.4%) had high-risk endometrial cancer, compared to only eight patients (13.8%) in the older age group. CONCLUSION: In contradiction to previous reports, our results show that a higher proportion of young indigent women diagnosed with endometrial cancer have a high-risk cancer. Delay in diagnosis can explain only some of the discrepancies in the special clinical pattern of endometrial cancer among this population. Other possible explanations include nutritional differences, genetic susceptibility, immunological status, and high-risk behavior. More epidemiological studies are needed for complete understanding of the unfavorable outcome of endometrial cancer in these young women.     

Racial disparities in young women with endometrial cancer

Objective

Although racial disparities in treatment and outcome for endometrial cancer are well recognized, little work has explored disparities in young women. We performed a population-based analysis to compare survival between black and white women with endometrial cancer at < 50 years of age.

Fertility-preserving treatment in young women with endometrial cancer

Nonsurgical fertility-preserving treatment of well-differentiated endometrial cancer with systemic progestins has been described for young women who desire to preserve their fertility. The overall response to progestin treatment in 9 retrospective studies is 79% with 79 subsequent live births. Recurrence can be expected in approximately 36-40% of conservatively treated patients who initially responded. Synchronous ovarian cancer has been reported in approximately 9%. However, amongst 162 receiving systemic, continuous treatment with progestins no death caused by cancer has been reported. We review guidelines for diagnosis, treatment and follow-up in young women undergoing conservative treatment for endometrial cancer.     

子宫内膜癌保留生育功能的治疗

对于年轻未生育子宫内膜癌患者的治疗目前存在较多争议。文章结合临床实践体会和文献报道,重点就其适应证选择、治疗前评估、治疗方案、疗效评价、病情监测、治疗后的生育问题、完成生育后的处理等做一阐述。     

Coexisting ovarian malignancy in young women with endometrial cancer

OBJECTIVE: In premenopausal women with endometrial cancer, ovarian preservation may be a consideration. Our objective was to examine the occurrence of coexisting ovarian malignancy and to identify predictors of adnexal involvement. METHODS: With institutional review board approval, a retrospective chart review was conducted of young women with endometrial cancer identified at 4 affiliated institutions from 1996 to 2004. RESULTS: Among 102 young women (aged 24-45 years) who underwent hysterectomy for endometrial cancer, 26 (25%) were found to have coexisting epithelial ovarian tumors: 23 were classified as synchronous primaries, and 3 as metastases. Ovarian cancer histology was endometrioid in 92% of cases. Among the 26 cases of coexisting ovarian involvement, 12 (46%) had grade 1 endometrial cancer on preoperative biopsy, 4 (15%) had normal preoperative imaging of the adnexa, and 4 (15%) had benign-appearing ovaries at the time of intraoperative assessment. On final pathology, 18 of 26 cases (69%) occurred in patients with grade 1 endometrial cancers, and 15 (58%) occurred with inner myometrial invasion. Our study further highlights the risk of conservative management with 1 case of ovarian cancer diagnosed 9 months after hysterectomy with ovarian conservation for a stage IA, grade 1 endometrial cancer and a case of advanced endometrial cancer metastatic to the ovaries developing 3 years after successful resolution of a grade 1 endometrial cancer treated with megestrol acetate (Megace). CONCLUSION: Careful preoperative and intraoperative assessment of the adnexa is mandatory in young women with endometrial cancer. Those who desire ovarian preservation should be counseled regarding the high rate of coexisting ovarian malignancy.     

Risk factors for young premenopausal women with endometrial cancer

OBJECTIVE: Endometrial cancer is the most common gynecologic malignancy in the United States. The mean age at diagnosis is 61 years; however, 5-30% of women are aged younger than 50 years at the time of diagnosis. The objective of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed in premenopausal women aged younger than 50 years, to better identify the risk factors for this subgroup of women. METHODS: We conducted a retrospective cohort study of patients with histologically confirmed endometrial cancer treated at the University of Texas, M. D. Anderson Cancer Center from 1989 to 2003. Clinical characteristics including age, body mass index (BMI), parity, diabetes, and personal or family history of cancer were obtained from the medical record. Pathologic information was obtained from pathology reports. RESULTS: Twelve percent (188/1531) of all patients with endometrial adenocarcinoma were aged younger than 50 years. The mean age at diagnosis was 41 years (range 21-49 years). Mean BMI was 34 kg/m(2) (range 18-68); 58% of patients had a BMI of 30 or greater. Fifty-five percent were nulliparous and 39% reported irregular menstrual cycles. The incidence of both diabetes and hypertension was 23%. Thirty-six patients (19%) had synchronous ovarian cancers. CONCLUSION: We found that the majority of patients diagnosed with endometrial cancer at a young age were obese and nulliparous. In addition, we found a high incidence of synchronous primary ovarian cancers in this cohort of young, premenopausal women.     

Continued medical treatment for persistent early endometrial cancer in young women

ObjectiveWe aimed to investigate the effectiveness of continuing medical therapy in patients who did not achieve complete response (CR) despite 9 months of progestin treatment. We also sought to determine the prognostic factors associated with achieving CR among these patients.MethodsWe retrospectively analyzed 51 patients with presumed stage IA, grade 1 or 2 endometrioid adenocarcinoma who had persistent disease on biopsy performed at 9–12 months after at least 9 months of progestin-based therapy. Data on clinicopathological factors and oncological and obstetrical outcomes following continuous hormonal treatment were extracted from the patients' medical records and analyzed. Univariate and multivariate analyses for predicting CR were performed.ResultsThirty-seven (72.5%) of 51 patients achieved CR after prolonged fertility-sparing treatment. Median time to CR from starting initial progestin was 17.3 months (range, 12.1–91.7 months). On univariate analysis, history of polycystic ovarian syndrome, histologic grade 2, and not achieving partial response (PR) until 12 months were significantly associated with failure to CR (odds ratio [OR], 6.188, 95% confidence interval [CI], 1.405–27.244, p = 0.018; OR, 9.722, 95% CI, 1.614–58.581, p = 0.013; and OR, 21.750, 95% CI, 4.016–117.783, p < 0.001, respectively). Multivariate analysis revealed that not achieving PR until 12 months was an independent prognostic factor predicting failure to CR after prolonged progestin therapy (OR, 21.803, 95% CI, 3.601–132.025, p = 0.001).ConclusionsContinued medical treatment is effective for persistent early endometrial carcinoma after at least 9 months of progestin therapy in young women who want to preserve their fertility.     

年轻早期子宫内膜癌保留生育功能治疗

随着女性生育年龄的推迟,年轻早期子宫内膜癌患者比例将会逐步升高。考虑到多数年轻早期子宫内膜癌患者具有肿瘤分化程度好、病变局限和对孕激素治疗有效等特点,保留生育功能的治疗方式逐渐受到重视。文章就此问题进行简要阐述。     

Clinicopathological analysis of endometrial carcinoma in young women

Endometrial carcinoma in 40 women under 40 years of age (group A), was analyzed clinicopathologically in comparison with that in 126 women over 50 years of age (group B). 1. The incidence of endometrial carcinoma in women under 40 years of age tends to increase. 2. Sixteen (41.0%) of 39 patients in group A had adenoacanthoma, while 28 (23.7%) of 118 patients in group B had it. The tumor in group A was characterized by less myometrial invasion, lower metastatic potential and coexisting endometrial hyperplasia than that in group B. 3. In group A, patients having ovaries with corpus luteum were characterized by less coexisting endometrial hyperplasia and more myometrial invasion than patients having ovaries without corpus luteum.     

Conservative management of endometrial stromalsarcoma in young women

Lissoni A, Cormio G, Perego P, Gabriele A, Cantú MG, Bratina G.Conservative management of endometrial stromal sarcoma in young women. Int J Gynecol Cancer 1997; 7 : 364–367.
Endometrial stromal sarcoma (ESS) is a rare malignancy with an associatedpoor prognosis. Total abdominal hysterectomy is considered the treatment ofchoice, and the role ofconservative, fertility-sparing surgery in young patients desiring pregnancy isnot well-defined.
Six patients were managed conservatively for ESS between 1982 and 1996 atour institution. The sources of tissue for diagnosis were polyps or myomasremoved for relief ofsymptoms. Median age of the patients was 27 years (range 18–36), and allwere nulliparous. One patient had a high-grade ESS (12 mitoses per 10 HPF) withextensive necrosis andatypia. The remaining five patients had a low-grade ESS, with a median mitoticcount of 4 per 10 HPF (range 2–6). In all cases the tumor was completelyresected, with a saferesection margin of at least 2 mm. No patients received adjuvant treatment.
At a median follow-up of 51 months (range 12–84) all patients arealive and well without recurrence. Two patients (33%) had a spontaneousdelivery at term, whereas one patient had a miscarriage at the 8th week ofgestation.
Conservative management of endometrial stromal sarcoma may be attempted inselected patients desiring pregnancy. Adequate follow-up is mandatory in orderto detect recurrence assoon as possible. Considering the indolent growth of low-grade ESS, definitivesurgery can be postponed until after completion of the reproductivefunction.     

Management of unilateral and encapsulated ovarian cancer in young women

Unilateral encapsulated ovarian cancer of the epithelial variety may be safely managed by conservative operation in young women who are desirous of childbirth, provided the opposite ovary is normal and the tumor is not ruptured. The lesion must be a low-grade ovarian neoplasm (Grade 1 or 2). Whether the tumor is serous or mucinous probably is of little consequence, as suggested by our previous studies.⁶ Bisection of the opposite ovary with wedge biopsy is recommended, and there must be frequent follow-up. The late recurrences (27 and 32 years after operation) noted in the opposite ovary of two patients in our series suggest that reoperation and definitive surgery should be considered after the patient's childbearing is complete.     

Outcome of fertility-preserving treatment in young women with endometrial carcinomas

OBJECTIVE: To evaluate the outcome of conservative treatment of young women with endometrial cancer. DESIGN: Observational study. SETTING: Gifu University Hospital, Japan from 1988 to 2002. POPULATION: Twelve women with endometrial cancer, FIGO IA estimated by MRI under 35 years. METHODS: Patients were treated with medroxyprogestreone acetate (400-600 mg/day) for 6-10 months, with endometrial curettage performed every four weeks. MAIN OUTCOME MEASURES: Response to therapy, pregnancies and reoccurrence of disease during follow up over a 30-month period. RESULTS: All cases had pathological complete remissions within 6-10 months. Seven of 10 wishing to have babies conceived, and five of them were delivered of full-term babies. Eight of nine cases receiving long term follow up (over 30 months) developed recurrent disease, with four opting for hysterectomy. No patient developed distant metastases or had disease-related death. CONCLUSION: Conservative therapy is feasible in carefully selected young women with endometrial cancer. Recurrence rates were high during long term observation even after pathological complete remissions. Therefore, close follow up is recommended.     

子宫内膜癌保留生育功能的治疗

未生育的年轻子宫内膜癌患者常常寻找保留生育功能的治疗方法。本文的主要目的是复习有关子宫内膜癌患者保留生育功能治疗的相关文献,探讨适合进行保留生育功能治疗的患者特征、治疗前的评估、治疗方案、疗效以及妊娠率。     

Vaginosonographic detection of endometrial cancer in postmenopausal women

In a prospective study 155 postmenopausal women not on hormone treatment underwent a vaginal ultrasound investigation. All women were routine patients of the regular ambulance. In addition to uterus biometry, the endometrial thickness was also measured. An endometrium of greater than or equal to 4 mm thickness was clarified histologically by means of a curettage. In total we found 7 endometrial cancers and 1 cervical cancer. Vaginal sonography proved to be a very sensitive (81%) and specific (89%) method for the detection of endometrial neoplasia.     

年轻子宫内膜癌患者保留卵巢的风险评估

目的:探讨年轻子宫内膜癌患者合并卵巢恶性病变的高危因素,从而对年轻早期内膜癌患者保留卵巢的安全性进行评估。方法:回顾2005年11月～2009年12月在我院行手术治疗的238例≤45岁子宫内膜癌患者的临床病理资料,分析子宫内膜癌患者发生卵巢恶性病变的高危因素,并随访了37例保留单侧或双侧附件的患者。结果:13例(5.5%)患者合并卵巢恶性肿瘤,其中8例(3.4%)为子宫内膜癌卵巢转移,5例(2.1%)为原发双癌。多因素分析子宫内膜癌卵巢转移的危险因素,按危险强度排列为组织学类型、宫颈受累、血清CA125水平及卵巢包块大小;而原发双癌的危险因素仅为卵巢包块大小。对37例保留单侧或双侧附件的患者进行定期随访,平均随访时间28.7±12.4个月(6～57个月),期间未发现复发病例。结论:5.5%的子宫内膜癌患者合并卵巢恶性肿瘤,保留其卵巢具有很大风险,对有强烈愿望保留卵巢的年轻患者必须进行充分的术前及术中评估,全面的医患沟通及术后随访亦必不可少。     

Cervical cancer in young Japanese women

This study was performed to determine whether the incidence of cervical cancer in women aged 35 or younger has changed over the last 10 years and to examine the clinical characteristics of the cases. The incidence of cervical cancer in women aged 35 or younger were significantly greater in 1987–1991 than 1992–1996 (p = 0.001). Most new cases were detected by routine cytological screening. Received: 28 May 1999 / Accepted: 14 February 2000     

Invasive cervical cancer in young women

Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10-year disease-free survival, determined by the life-table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage II (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph-node involvement, 10-year actuarial survival decreasing from 93% in lymph-node-negative to 44% in lymph-node-positive patients (P less than 0.001). The prognostic relevance of the clinical stage decreased after adjustment for lymph-node involvement, but the statistical significance of lymph-node involvement was unaffected when stage was allowed for. In the present series, the estimated 10-year disease-free survival was 80% in patients treated by radical hysterectomy compared with 62% in the group treated by total hysterectomy (stage IB to IV patients only); this difference, however, was not statistically significant when the data were adjusted for clinical stage (P = 0.10). None of the 20 patients with recurrent disease could be managed successfully.     

Uterine cervix cancer in young women

42 women with uterine cervix cancer, all under the age of 25, who were treated at the Warsaw Institute of Oncology during 1946-1965, were investigated as to course of disease, treatment, and outcome of treatment. These women composed .5% of all the women treated at this institute during this period for uterine cervix cancer. In this group a larger number of low-maturity microscopic patterns was noted, along with quicker development of the neoplasm and an increased number of inflammatory complications. Results of the treatment were generally worse among patients of this group.